UTI

Question 1

What is an uncomplicated UTI?

Answer 1

Normal renal tract and function

Question 2

What are complicated UTIs?

Answer 2

UTI with any of: 
abnormal renal/GU tract
voiding difficulty/obstruction
impaired renal function 
impaired host defences
virulent organisms e.g. staph aureus

Question 3

What are risk factors for UTIs?

Answer 3

F>M
Sexual intercourse
Pregnancy 
menopause
immunosuppression, DM
UT obstruction, malformation, stones
Catheter

Question 4

Why is it necessary to do routine dipsticks in pregnancy?

Answer 4

UTIs common and often asympomatic until serious pyelonephritis leading to prem

Question 5

How should infected urine in catheters be dealt?

Answer 5

always infected so treatment is pointless

MSU if symptomatic

Question 6

What are the main causative organisms?

Answer 6

E.coli (main)
Proteus mirabilis
Klebsiella pneumonia
Staph saprophyticus

Question 7

Give the sx found in:

i. acute pyelonephritis
ii. cystitis
iii. prostatitis

Answer 7

i. high fever, riggers, vomiting, loin pain + tenderness, oliguria (if AKI)
ii. frequency, dysuria, urgency, haematuria, suprapubic pain
iii. flu like sx, low back ache, feel urinary sx, swollen/tender prostate on PR

Question 8

What are the signs found in UTIs

Answer 8

fever
abdo, loin tenderness
foul smelling urine
distended bladder
enlarged prostate

Question 9

What MSU finding is diagnostic of UTI?

Answer 9

> 10^5 organisms/ml

Question 10

What are the tests for UTI and when are they indicated?

Answer 10

1. dipstick - non-pregnant woman <65yrs w less than 3 sx
2. MSU - pregnant, men, children and failing to respond to abx
3. FBC, U+E, CRP, blood cultures if systemically unwell
4. Imaging - USS + referral to urology if child, man, fails to respond to abx, recurrent UTIs, pyelonephritis, weird organism or persistent haematuria

Question 11

When are no investigations indicated in UTI?

Answer 11

non-pregnant women w 3 or more (or one) sx of cystitis and no vaginal discharge

Question 12

How is a diagnosis of pyelonephritis made?

Answer 12

MSU

Loin pain +/- fever + UTI confirmed in MSU + other causes excluded

Question 13

What signs and sx would make u suspect pyelonephritis?

Answer 13

Sx of UTI (dysuria, frequency etc)

Sx of pyelonephritis (fever, N&V, flank pain)

Question 14

What is the treatment of pyelonephritis in non-pregnant women and men >16yrs

Answer 14

Oral abx: cefalexin (or co-amox, trimeth, cipro if susceptible organisms)
IV abx: co-amox, cefuroxime, ceftriaxone (IV if severe or vomiting)

Question 15

What is the treatment of pyelonephritis in pregnant women >12yrs

Answer 15

oral: cefalexin
IV: cefuroxime

Question 16

What parts of the urinary tract are affected in a:

i. lower UTI
ii. upper UTI

Answer 16

i. urethra, cystitis, prostate

ii. renal pelvis

Question 17

What are the causes of sterile pyuria

Answer 17

Treated UTI <2w prior
Inadequately treated UTI
Appendicitis
Calculi, prostatitis
Bladder tumour 
Papillary necrosis
Polycystic kidney
Tubulointerstitial nephritis
Chemical cystitis e.g. cyclophosphamide